Plan Year 2021 Enrollment Book - Flex Spending Account - University at Albany
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Plan Year 2021
Enrollment Book
Flex Spending Account
Dependent Care Health Care Adoption
Advantage Account Spending Account Advantage Account
Table of Contents
3 About The Flex Spending Account
Important Dates
To Remember 4 How To Enroll
Open enrollment period
is November 2 through 5 Claims Process
November 30, 2020 at
10:00 p.m. ET.
6 Worksheets
If you are enrolled for the 2020 plan year, you
must re-enroll to continue your benefits in 2021.
The 2021 plan year runs from January 1 through 7 Manage Your Account
December 31, 2021.
New state employees hired during the open
enrollment period who are unable to enroll by 8 Flex Spending Account FAQs
the November 30 deadline because they have
not been assigned a NYS EMPLID may enroll
for the 2021 plan year by submitting a 2021
change in status (CIS) application within 60 9 Health Care Spending Account
days of their hire date. The 2021 CIS system will
be available beginning on December 1, 2020.
14 HCSA FAQs
16 Dependent Care Advantage Account
20 DCAA FAQs
22 Adoption Advantage Account
23 2021 Open Enrollment Calendar
2 800-358-7202
About The Flex Spending Account
What Is The Flex Spending Account? Fees
The Flex Spending Account (FSA) is a negotiated benefit for state There are no fees for employees who participate in the FSA
employees. There are three parts to the FSA—the Dependent Care program. The FSA is funded by the Governor’s Office of Employee
Advantage Account (DCAA), the Health Care Spending Account Relations in cooperation with the state public employee unions.
(HCSA), and the Adoption Advantage Account. They are types The Legislature and Unified Court System also contribute on
of flexible spending accounts, administered in compliance with behalf of their employees.
Sections 125 and 129 of the Internal Revenue Code, that give you
a way to pay for your dependent care, health care, or adoption FSA Administrator
expenses with pre-tax dollars. Enrollment in the FSA is voluntary— The State of New York retains the services of an FSA administrator
you decide how much to have taken out of your paycheck and to manage the Flex Spending Account. HealthEquity (formerly
put into your accounts. WageWorks) is the FSA administrator.
Why Should I Enroll? The FSA administrator reviews and reimburses claims and provides
If you are paying for dependent care expenses in order to work, customer service and accounting services. Flex Spending Account
have medical expenses that are not covered by your health participants submit all claims for reimbursement directly to the
insurance plan, or are planning to finalize an adoption, you are FSA administrator.
paying for those expenses with dollars that have already been
During the plan year, the FSA administrator will provide your
taxed. By enrolling in the FSA, you will pay for your dependent
account balance with each reimbursement check or direct deposit
care or health care expenses with whole dollars—before federal,
stub. You will also receive quarterly and year-end statements that
state, and social security taxes are taken from your salary. You
detail the activity in your account.
will also save on your adoption expenses because you will pay
lower federal and state taxes due to your pre-tax contributions
(where applicable). Plan Your Contribution Amount Carefully
Because of the tax advantages of the FSA, the Internal Revenue
Service (IRS) has strict guidelines for its use. One of these guidelines
How Does The Flex Spending Account Work? is commonly known as the “use it or lose it” rule. Put simply, if you
The FSA is easy to understand and to use. You may choose to
contribute pre-tax dollars into your FSA account and then do not
enroll in any or all of the three benefit choices. This is how it works:
have enough eligible expenses during the plan year to equal the
During the open enrollment period, use the HCSA and DCAA amount you contributed, you will lose the balance remaining in
worksheets to estimate your out-of-pocket health care and your account when the plan year ends. That is why it is important
dependent care expenses for the calendar year. Based on your to plan carefully before deciding how much to contribute. With
estimate, decide how much of your salary you want to set aside careful planning, you can minimize the risk of losing any of your
in either or both accounts. For the Adoption Advantage Account, contributions. Participants have until March 31, 2022 to submit
estimate your qualified adoption expenses for the plan year. Submit any eligible unreimbursed expenses from the 2021 plan year.
your enrollment application online or by calling the toll-free number But remember—if you plan properly, you are unlikely to forfeit
before the open enrollment period ends. any of your funds.
Each pay period, a regular portion of these amounts will be In addition, if you enroll in more than one FSA benefit, funds can’t
deducted tax-free from your biweekly paycheck. These deductions be transferred between accounts.
are made before your federal, state, social security, and city (if
applicable) income taxes are calculated. The contributions to your
FSA are deducted tax-free from your gross pay.
Open Enrollment is
November 2 through
November 30, 2020.
goer.ny.gov/FSA 3
About The Flex Spending Account
Effect On Other Benefits Your appeal will be reviewed once it and the supporting
Social Security Tax (FICA) documentation are received. You will be notified of the results of
Contributions to the FSA may reduce your social security taxes. If so, this review within 30 business days from receipt of your appeal.
based on current social security law, social security benefits at your In unusual cases, such as when appeals require additional
documentation, the review may take longer than 30 business
retirement age may be slightly less as a result of your participation in
days. If your appeal is approved, your account will be adjusted as
the FSA program. The effect will be minimal and would likely be offset soon as possible. Appeal decisions are based upon whether your
by the amounts saved in taxes today. If you are concerned about circumstances and supporting documentation are consistent with
this, contact the Social Security Administration at 1-800-772-1213 the FSA rules and IRS regulations governing the plan.
or visit www.ssa.gov.
New York State Pension
Contributions to the FSA have no effect on your New York State
pension contributions or benefits.
How To Enroll
You will need to have your NYS EMPLID, department ID, and
Deferred Compensation negotiating unit information available to complete your enrollment
Most employees’ contributions to the New York State Deferred application. This information can be found on your most recent
Compensation Plan will be unaffected by participation in the FSA paystub.
program. In some cases, however, participation in the FSA program
Use the worksheets on page 6 to help you estimate your expenses
may affect you. The percentage you contribute to the deferred
for the plan year. Based on your estimate, decide how much of
compensation plan will be applied to a lower salary amount as
your salary you want to set aside in your accounts. The amount you
a result of your FSA contributions. Since such contributions are
choose is taken out of your paycheck through automatic payroll
made as a percentage of salary, your deferred compensation
deductions. The number of payroll deductions will be determined
contribution may be lower, depending on the amount of your
based on the number of paychecks you expect to receive during
annual salary and the amount you currently contribute to your
the plan year and will be made before your state, federal, and social
deferred compensation plan.
security and city income (if applicable) taxes are calculated. If you
SUNY Deferred Annuity Plan expect to be on the state payroll for the entire year, deductions
Contributions to the State University of New York’s tax-deferred will be taken from a maximum of 24 paychecks.
annuity plan are not affected by participation in the FSA program.
You can apply online at goer.ny.gov/FSA or by telephone at
1-800-358-7202. Customer service representatives are available
Changing Your Coverage
Monday through Friday between 8 a.m. and 8 p.m. ET.
Am I permitted to make election changes after the plan year
begins? After your application is processed, you will receive a letter from
If you have a qualifying event, you may be able to make a change the FSA administrator confirming your annual elections.
to your FSA election by submitting a change in status application.
Your FSA enrollment lasts for only one year. Re-enrollment is not
Can I enroll during the plan year? automatic.
If you have a change in status event that occurs after the open
enrollment period ends, you may be able to enroll during the plan Important Reminder
year. Please refer to the respective HCSA and DCAA sections for IRS regulations do not allow exceptions if you miss the open
specific information on changes in status. enrollment deadline, regardless of your reason. Enroll early to
avoid long hold times or other issues that may occur during the
Appeal Process last few days of the open enrollment period that could cause you
If your change in status, claim, or other request is denied, in full to miss the deadline.
or in part, you have the right to appeal the decision by sending a
written request to the FSA administrator. Contact customer service
for information on how to submit your appeal.
Your appeal must include:
• The name of your employer – State of New York
• The date of the services for which your request was denied
• A copy of the denied request
• The denial letter you received
• Why you think your request should not have been denied
• Any additional documents, information, or comments you think
may be relevant to your appeal
4 800-358-7202
Claims Process
How Do I Submit My FSA Expenses For 31 to submit claims for services rendered from January 1 through
Reimbursement? December 31 of the preceding year.
After you have received services and incurred eligible expenses,
you can choose from several options to be reimbursed for your Special Rules For HCSA Claims
expenses. Submit claims after you have received health care services and
know the amount of the bill for which you are responsible. Include
• Using Your Smartphone Or Mobile Device a statement from your health insurance plan showing the amount
With the EZ Receipts mobile app, you can file and manage of the medical expense that has not been reimbursed or attach
your claims on the spot, with a click of your smartphone or copies of receipts, billing statements, invoices, or other appropriate
mobile device camera. After you download the free app to your supporting documentation from the health care provider. Canceled
smartphone or mobile device, just snap and submit photos checks or credit card receipts will not be accepted. The receipts,
of your receipts, making it easy to verify transactions later. billing statements, or invoices must include the:
You can even let daycare providers sign eligible expenses
directly within the app. • Name of the person for whom the service was provided
• Your HealthEquity Healthcare Card • Name and address of the health care provider
The HealthEquity® Healthcare Card, a preloaded debit card, • Amount charged for each service
is a quick and easy way to pay for eligible healthcare products • Type of service and the date performed
and services right from your Health Care Spending Account.
• If a prescription drug expense, a receipt containing the
Use your Card instead of cash or credit to pay for eligible
prescription number and drug name
services, goods, and prescriptions at health care providers,
pharmacies, and most general merchants. It’s easy to just swipe
Special Rules For Orthodontia Claims
and go. In most cases, card transactions are automatically
If you are on a monthly payment plan for orthodontia services,
verified, but save your receipts with the EZ Receipts mobile
you may submit a request for reimbursement after each monthly
app. Please note that the Card can’t be used to pay for dental,
payment is due, even if no office visit takes place during that month.
orthodontia, dependent care, or adoption expenses.
If you pre-pay the entire orthodontia expense up front when
• Paying Your Provider Online treatment begins, you can’t be reimbursed for the entire amount
at one time. Rather, the amount will be pro-rated and reimbursed
You can pay many of your eligible health care and dependent
over the course of treatment. You will need to submit a claim for
care expenses directly from your FSA account with no need
the pro-rated monthly amount on or after the beginning of each
to fill out paper forms. It’s quick, easy, secure, and available
month of service, since you will not be reimbursed automatically.
online at any time. After you log into your FSA account, click
A copy of the orthodontia contract must be included with your
Submit Receipt or Claim, then request Pay My Provider from
first claim for the plan year.
the menu and follow the instructions. Make sure to provide
an invoice or appropriate documentation. When you’re done,
HealthEquity will schedule the checks to be sent in accordance Special Rules For DCAA Claims
with the payment guidelines. If you pay for eligible recurring The FSA administrator will review your claim and if it is complete, will
expenses, follow the online instructions to set up automatic authorize it for payment up to the amount of money accumulated
payments. in your account.
• Filing A Claim Online If you submit a claim for more money than you have in your
You also can file a claim online to request reimbursement for DCAA, the balance will be paid automatically when the funds
your eligible FSA expenses. Log into your FSA account and are deposited from your next payroll deduction.
click Submit Receipt or Claim, then select Pay Me Back. Fill If dates of service for which you are seeking reimbursement begin
in all the information requested on the form and submit. Scan in one plan year and end in the next plan year, a claim for each
or take a photo of your receipts, EOBs and other supporting year is required. The claim must include the provider’s name,
documentation, then attach the documentation to your claim address, and taxpayer ID number (or social security number), the
by using the upload utility. period during which the services were provided, and the amount
Most claims are processed within one to two business days after you were charged. Submit a receipt or invoice with the claim form,
they are received, and payments are sent shortly thereafter. or you can have your provider countersign the form with you.
If you prefer to submit a paper claim by fax or mail, download Claims are paid after services are received, regardless of when
a Pay Me Back claim form at goer.ny.gov/FSA and follow the you pay for the expenses. If you would like, you can prorate a
instructions for submission. large expense as the services are rendered and submit claims
as often as you would like.
After the plan year ends on December 31, you have until March
goer.ny.gov/FSA 5
Worksheets
To help you plan the amount of your HCSA or DCAA contribution, use these worksheets. You may want to look at what you spent on
health care and dependent care last year before making your decision. Include annual estimated expenses for health care services
anticipated for the upcoming plan year that will not be reimbursed by your medical, dental, or other benefit plans. You may include
expenses for you, your spouse, your qualifying children, and your qualifying relatives. You should also verify with your health care
provider that you are a suitable candidate for any surgical procedure, such as laser eye surgery, before committing the money to
your account.
If you are enrolling during the open enrollment period, use the chart below to estimate your expenses for the plan year. If you are
joining the program with a change in status during the year, use the chart to estimate your expenses for the remainder of the calendar
year. If you are a new employee, your HCSA coverage will begin on your 61st consecutive calendar day of employment.
HCSA WORKSHEET DCAA WORKSHEET
Estimate your eligible, uninsured out-of-pocket medical Estimate your eligible dependent care expenses for the plan
expenses for the plan year. year. Remember that your calculated amount cannot exceed
the calendar year limits established by the IRS.
Medical expenses, such as:
Child Care Expenses
Health plan deductible $___________
Babysitter $___________
Office visit and hospital copayments $___________
Daycare services $___________
Prescription drug copayments $___________
Nursery school $___________
Routine physicals $___________
Before/after school care $___________
Non-covered prescriptions $___________
Summer day camp $___________
Hearing aids $___________
Planned, non-covered medical procedures $___________ Elder Care Services
Other eligible expenses $___________ Adult daycare center $___________
Disabled dependent care $___________
Dental expenses, such as:
Other expenses $___________
Deductibles and copayments $___________
Routine check-ups, cleaning, and x-rays $___________ Total Expenses Remember, your total
contribution cannot exceed the IRS limit of
Orthodontia $___________
$5,000 for the plan year and calendar year. $___________
Non-cosmetic dental work (crowns, dentures,
dental implants, etc.) $___________ Divide by the number of paycheck deductions
you will receive during the plan year (24 max).___________
Vision care expenses, such as:
Exams $___________ This is your biweekly contribution. $___________
Eyeglasses $___________
Contact lenses and contact lens solutions $___________
Total Expenses Remember, the minimum
contribution is $100, and the maximum
contribution is $2,750. $___________
Divide by the number of paycheck deductions
you will receive during the plan year (24 max).___________
This is your biweekly contribution. $___________
6 800-358-7202
Manage Your Account
Account Information If you decide to enroll in the direct deposit option, you will
Getting answers to many of your FSA questions is now easier than have quicker access to your reimbursements by eliminating
ever. The FSA administrator, HealthEquity, offers you a variety of mail time. To enroll in direct deposit, login to your account,
resources to make inquiries about your FSA. click on the Profile link at the top of the screen, then click on
the Reimbursement Method tab on the left side of the screen.
You will be able to access your account information by logging in to Enter your banking information on the screen and click on the
the FSA administrator’s participant site at participant.wageworks. Save Changes button. If you enroll in direct deposit and make
com/NYSFSA. Once logged in, you will see your account dashboard a change to your bank account at a later date, you will need to
and find answers to many of your questions by using the navigational update the banking information saved in your Profile.
tabs located near the top of the screen.
If you are enrolling in the FSA for the first time for the 2021 plan
Alerts & Messages
Click on the Alerts & Messages link at the top of the screen to
year, you will need to register as a first-time user. Click on the
view important messages and reminders about your account
Register link, then follow the instructions for the First-Time User
and the FSA program.
Registration process. You will need to enter the last four digits of
your NYS EMPLID in the ID Code box on the Identify Yourself
screen. Once you have completed the registration process, you
can access your online account information any time by logging
in to the participant site through goer.ny.gov/FSA.
FSA Claims
After you login to your online account, you can check the status
of your claims, download or view a report of your claims history,
access information about eligible FSA expenses, and submit your
claims online.
Accounts
View your account balance and reimbursement transactions and
download or view a report of your reimbursement history.
Profile
Click on the Profile link at the top of the screen to update your
contact information, change your password, select your preferences
for receiving information from the FSA administrator, authorize
individuals to contact the FSA administrator about your account,
and select the method for receiving claims reimbursements.
goer.ny.gov/FSA 7
Flex Spending Account FAQs
Will money in the FSA ever be subject to taxes, or is it free What happens if I submit a claim for an amount greater
from taxes? Money used for qualified expenses from the FSA is than my FSA balance? When you submit an eligible claim to
free from taxes. the HCSA, you will be reimbursed up to the full amount of your
annual election, regardless of the amount of money that has been
How much money will I save by enrolling in the FSA program? deposited into your account. Contributions will continue through
Your savings will be based upon your individual income and payroll deductions throughout the year and claims will continue
tax filings. to be paid until your elected annual contribution amount is met.
Does the State guarantee the tax benefits under the FSA? Dependent care and adoption claims are paid differently. If you
No. The State cannot guarantee that a participant will receive the submit a claim and your balance is less than the amount of the claim,
intended tax benefits. It is up to each participant to make sure you will only be reimbursed for the amount of money available in
that contributions are made for eligible expenses within the legal your account. The remainder will be reimbursed once the money
and plan limits. is deposited into your account. This enables you to submit a claim
only once and receive reimbursement on an ongoing basis until
What responsibilities do I have to ensure the intended tax
it is paid in full.
benefits of the program are received? You should make sure that
contributions to the FSA will only be made for eligible expenses, What if I don’t use up all my money by the end of the year?
for qualifying individuals, up to the legal or plan maximum, and for You will forfeit the money that remains in your account. You will have
services provided in the same plan year the contributions are made. until March 31, 2022 to submit claims for expenses you incurred
during the 2021 plan year. You should plan very carefully when
Wouldn’t I save more by taking a deduction on my income
estimating your expenses. The FSA administrator will notify you
tax? You need to determine whether taking a tax deduction is
during the last quarter of the plan year if you are likely to have
more beneficial than using the FSA. According to the IRS, only
money left in your account. The State uses forfeitures to offset
medical and dental expenses that exceed 7.5% of your adjusted
the costs of administering the program.
gross income can be deducted from your income taxes. Most
people do not have expenses high enough to qualify for this What if I change my mind? You may not change your mind
deduction. For work-related dependent care expenses, the tax once the plan year begins, but you can decide not to join next
credit amount is determined by applying a percentage to your total year. There are certain situations, called “changes in status,” and
dependent care expenses. In addition, money set aside through if they occur in your family during the plan year, you can make a
your HCSA and DCAA is exempt from FICA taxes. This exemption change—you can start, stop, restart, or change your deduction
is not available on your federal income tax return. When it comes amounts as long as the requested change is consistent with your
to adoption-related expenses, it is recommended that you only qualifying event. The change in status application process is
use the FSA for expenses in excess of the tax credit amount. If paperless. You may file a change in status application online or
you enroll in an adoption FSA, you will save on federal and state by calling the FSA administrator at 1-800-358-7202.
taxes (where applicable).
If I underestimate or overestimate my elections, can I transfer
If I reside outside of New York State, how will my participation money between my FSA accounts? No, you can use monies
in the FSA be affected? Most states follow the federal rules; only for the purpose for which the election was initially made.
however, some states may tax the FSA contributions. You must IRS Regulations do not allow monies to be transferred between
comply with the laws of the state where you reside. accounts.
Do contributions to my FSA reduce my income for purposes of How long is my contribution in effect? Your contribution is in
the Federal Earned Income Tax Credit (EITC)? Yes. Contributions effect until the end of the plan year. Each year you will have the
to your FSA will reduce your earned income for purposes of the opportunity to re-enroll and select a new annual contribution
Federal EITC. This means that participation in the FSA may affect amount.
your EITC — an additional advantage of participation in the pre-
tax FSA program.
How would I determine if participating in the FSA would
affect my social security benefits? Participation in the FSA
may have a minimal effect on your social security benefits upon
retirement. The Social Security Administration (SSA) uses the
highest 35 years of salary earned before retirement to calculate
your social security benefit. However, if you are concerned, you
should call the SSA for further advice at 1-800-772-1213 or visit
www.ssa.gov.
8 800-358-7202
Health Care Spending Account
What Is The Health Care Spending Account? 2. UUP-represented employees employed by SUNY are eligible
The Health Care Spending Account (HCSA) is a negotiated if they:
employee benefit that helps state employees pay for health-related • Are permanent employees or are expected to be employed
expenses with tax-free dollars. This includes medical, hospital, by New York State for the entire calendar year (employees
laboratory, prescription drug, dental, vision, and hearing expenses who are hired on a semester basis are eligible if they meet
that are not reimbursed by your insurance, or other benefit plans. the other criteria below) and
Before enrolling in the HCSA program, you should carefully consider • Receive regular, biweekly paychecks and
what your eligible expenses might be. Reviewing your expenses
• Are eligible to enroll in the New York State Health Insurance
from previous years can help. Once you have estimated the amount
Program and
of your expenses, you may then determine how much to contribute
to your HCSA. Under federal law, any money that you put into your • Are academic employees who teach two or more courses
HCSA must be used for expenses incurred during the plan year per semester at a single university or
in which it was contributed. For the 2021 plan year, the maximum
• Are full-time professional employees or
annual contribution allowed is $2,750 and the minimum annual
contribution is $100. The maximum contribution may be subject • Are part-time academic or professional employees who are
to change annually. hired by a single university at a specified annual rate ($15,930
or more between July 2, 2020 and July 1, 2021)
Who Is Eligible To Enroll? 3. New employees must meet the eligibility criteria to participate
1. Employees who work for New York State Executive Branch
in the HCSA. Your period of coverage will start on your 61st
agencies (excluding UUP-represented employees), the State
consecutive calendar day of employment. You will be able to
University of New York (SUNY), and the Legislature, and non-
submit claims for eligible health care expenses incurred on or
judicial employees of the Unified Court System are eligible if
after that date through December 31 of the plan year in which
they:
you are enrolled. Deductions will start with the first payroll date
• Are permanent employees or are expected to be on the that occurs after you become eligible to submit claims.
payroll for the entire calendar year (employees who teach
on a school year schedule and are paid on a 10-month basis Who Is Not Eligible To Enroll?
are eligible if they meet the other criteria below) GSEU-represented, casual, seasonal, session, per diem, fee basis
and hourly employees, as well as retirees, are not eligible to
• Are employed on an annual-salaried basis participate in the HCSA.
• Receive regular, biweekly paychecks
• Work half-time or more on a regular schedule for a single
agency
• Are eligible to enroll in the New York State Health Insurance
Program
• Are represented by a negotiating unit that is eligible to
participate or are designated Management/Confidential.
Employees of Executive Branch agencies who are represented
by one of the following unions are eligible to participate in the
HCSA: CSEA, PEF, NYSCOPBA, Council 82, PBANYS, District
Council 37, PBA, and NYSPIA. In addition, all negotiating
units in the Unified Court System are eligible to participate.
Employees of the Roswell Park Cancer Institute, NYS Energy
Research and Development Authority, Environmental Facilities
Corporation and New York Liquidation Bureau are also allowed
to participate if they meet the eligibility criteria listed above.
All judges and justices of the Unified Court System, paid elected
officials, and paid members of the Legislature are eligible
regardless of their work schedule.
goer.ny.gov/FSA 9
Health Care Spending Account
What You Need To Know Before Enrolling When will I be reimbursed?
To be reimbursed through the HCSA, expenses must be for You can be reimbursed for your expenses as soon as you or your
health care received primarily for the prevention or treatment of dependents receive medical services. In addition, once you sign
a physical or mental defect or illness. Out-of-pocket expenses up for the HCSA and decide how much you want to contribute,
are generally eligible if they are not reimbursed by insurance. that total amount is available to you at any time during your period
Regardless of whether the expenses are incurred by you or your of coverage. It’s like a cash advance because you don’t have to
eligible dependents, they must be incurred during the plan year wait for the cash to accumulate in your account before you can
or during your period of coverage if you enroll after the plan use it to pay for your eligible health care expenses. Your money
year begins. An expense is incurred when you or one of your is tax free and interest free!
dependents receives the health care service, not when you are
billed, charged for, or pay for the service.
Whose Expenses Are Eligible For
Reimbursement?
To be eligible for reimbursement, a health care expense must be: You may claim eligible expenses under the HCSA program for
• For you or an eligible dependent the following individuals:
• Permitted under the Internal Revenue Code • Yourself
• Medically necessary • Your spouse
• Not reimbursed by your health insurance or any other benefit • Your qualifying child
plan, nor will you seek reimbursement from such plans • Your qualifying relative
Note: You can only be reimbursed for expenses that are incurred
An individual is a qualifying child if he or she:
during your period of coverage, which means:
• Is a U.S. citizen, national, or a resident of the U.S., Mexico, or
• If you enroll during the open enrollment period and remain on Canada
the state payroll for the entire year, your period of coverage is
from January 1 to December 31. • Has a specified family-type relationship to you
• If you enroll during the plan year as a new employee, your period • Lives in your household for more than half of the tax year
of coverage will begin after the completion of 60 consecutive • Is 18 years old or younger (23 years, if a full-time student) at
calendar days of state service. Your coverage will end on the end of the tax year
December 31. • Has not provided more than one-half of his or her own support
• If you enroll during the plan year as a result of a change in during the tax year (and receives more than one half of his or
status, your period of coverage will begin when your change her support from you during the tax year if a full-time student
in status application is received, although it can’t take effect age 19 through 23 at the end of the tax year)
before the date of your qualifying event. Your coverage will
end on December 31. An individual is a qualifying relative if he or she:
• If you enroll during the open enrollment period and experience • Is a U.S. citizen, national, or a resident of the U.S., Mexico, or
a mid-year change in status, you will have two separate periods Canada
of coverage from which expenses will be reimbursed.
• Has a specified family-type relationship to you, is not someone
else’s qualifying child, and receives more than one-half of his
or her support from you during the tax year
or
if no specified family-type relationship to you exists, is a member
of and lives in your household (without violating local law) for
the entire tax year and receives more than one-half of his or
her support from you during the tax year
Note: There is no age requirement for a qualifying child if he or
she is physically or mentally incapable of self-care. An eligible
child of divorced parents is treated as a dependent of both, so
either or both parents may establish a HCSA to be reimbursed
for the child’s health care expenses.
10 800-358-7202Health Care Spending Account
What Types Of Expenses Are Eligible?
Expenses are eligible for reimbursement if they are for medically necessary health care services. The expenses must be incurred
during the plan year or during your period of coverage if you enroll after the plan year begins. Examples of eligible expenses under
the HCSA are listed below.
Examples of Medically Necessary ELIGIBLE Expenses
Acupuncture Dental fees1 Infertility treatments Physical therapy
Alcoholism treatment Dentures Insulin and diabetic supplies Smoking cessation programs
Ambulance services Diagnostic tests Laboratory fees Surgery 1,4
Artificial limbs2 Dietary supplements1 Laser eye surgery4 Telephone for the
Breast pumps Drug addiction treatment Menstrual care products hearing-impaired
Chiropractic care Drugs (prescription only)3 Naturopathic healers Transplants of organs
Christian Science Eye examinations Nursing services1 Transportation5
practitioners Eyeglasses2 Orthopedic shoes1 Vaccinations
Contact lenses (corrective) Guide dog and service Orthodontia Vitamins1
Contact lens solutions dog expenses Oxygen Weight loss programs6
Copayments Hearing aids & exams Psychiatric care Wheelchairs
Crutches Holistic healers Periodontal fees
1 Some health care treatments or services, including those deemed cosmetic in nature, require written proof of medical necessity from your health care
provider with your initial claim and for each subsequent plan year that you participate.
2 The effective date that expenses are incurred (for example, eyeglasses and prosthetic devices) is the day the item is available to be picked up, not the date
ordered.
3 Not all drugs requiring a prescription are approved by the IRS as eligible for reimbursement. Prescription drugs that are used solely for cosmetic purposes
are not eligible for reimbursement.
4 Unused funds designated for the HCSA cannot be refunded to you. Please verify with your health care provider (prior to enrolling for the upcoming plan year)
that you are a suitable candidate for any surgical procedure before committing the money to your HCSA.
5 Must be primarily for, and essential to, medical care. Reimbursable expenses include 17 cents per mile (2020) for automobile use, parking fees, tolls, subways,
buses, trains and air travel.
6 Expenses incurred for weight loss programs may only be reimbursable if a physician prescribes the treatment as medically necessary to prevent, treat or
alleviate a specific, diagnosed medical illness (such as hypertension, diabetes, or obesity).
Ineligible Expenses
Certain health care expenses are not eligible for reimbursement from your HCSA, some of which are listed below.
Examples of INELIGIBLE Expenses
Contact lens insurance Fitness classes1 Items/services to improve Pilates
contracts Hair transplants general health Skating
Cosmetic procedures Health club memberships Marriage counseling Teeth whitening/bonding
Cosmetic surgery Herbal remedies Massage therapy 1 Tennis and other sports
Dance lessons Holistic medicines Meal replacements2 lessons
Electrolysis Homeopathic remedies Medicines purchased Yoga
Exercise equipment 1 Insurance premiums outside the U.S.
1 May be an eligible expense if prescribed by a doctor to treat a specific medical condition. Written proof of medical necessity is required.
2 Special foods may be an eligible expense if prescribed by a doctor to treat a specific illness or ailment and if the foods do not substitute for normal nutritional
requirements. Food modified for special diets (e.g., gluten-free) may also be eligible, but only to the extent that the cost of the special food exceeds the cost of
commonly available versions of the same product. Written proof of medical necessity is required.
goer.ny.gov/FSA 11Health Care Spending Account
Over-The-Counter Drugs
Over-the-counter (OTC) drug expenses are reimbursable through the HCSA as long as the items are used to treat a medical condition
or illness. Certain OTC expenses such as vitamins and dietary supplements are not reimbursable unless they are recommended by a
doctor to treat a medical condition. General purpose items such as toothpaste, moisturizers, and lip balm are not eligible expenses.
Eligible OTC Items
Acne treatments Cough drops & sore throat Insulin, testing materials OTC products for dental, oral, &
Allergy & sinus medicine lozenges & supplies teething pain
& products Cough syrup Laxatives Ovulation monitor (OTC)
Antacids Crutches, canes, walkers or Lice treatments Pain relievers
Antibiotic ointment like equipment (purchase or Medical equipment (for treatment Pregnancy tests (OTC)
Anti-itch & insect bite products rental) of a medical condition) & Propecia (for treatment of a
Aspirin or other pain relievers Diabetic monitors, test kits, strips repairs medical condition)
Asthma/respiratory medicines & supplies Medical monitoring & testing Reading glasses (OTC)
or treatments Diaper rash ointments & creams devices Retin-A (for non-cosmetic
Bandages & related items (OTC) Ear drops & wax removal Medical supplies (for treatment of purposes)
Birth control (OTC) Eye drops a medical condition) Sleep aids
Blood pressure monitors Eye related equipment/materials Menstrual care products Teeth grinding prevention
Canker & cold sore treatments Eyeglasses (OTC) Monitors & test kits (OTC) devices
Chest rubs Feminine anti-fungal/anti-itch Motion sickness & nausea Toothache & teething pain
Cholesterol test kits & supplies treatments medicines relievers
Cold & flu medicines Fertility monitors (OTC) Occlusal guards to prevent teeth Urological products
Condoms First aid kits (OTC) grinding Walking aids (canes, walkers,
Contact lenses, cleaning Gastrointestinal medications Orthotics crutches & related supplies)
solutions, etc. Hearing aids & batteries Orthopedic & surgical supports Wart removal treatments
Corn & callus removers Hemorrhoid treatments OTC bandages & related items Wound care (OTC)
Incontinence supplies
Ineligible OTC Items Eligible OTC Items That Require a Letter of Medical Necessity
Herbal medicines Items to improve general health Nutritional supplements
Holistic medicines Lip balm Vitamins
Homeopathic remedies Moisturizers
Toothpaste and toothbrushes
12 800-358-7202Health Care Spending Account
Changes In Status Payroll Changes
You may be eligible to enroll after open enrollment has ended or What happens if I leave the payroll during the plan year?
during the plan year if you experience a change in status (CIS) If you leave the payroll due to termination of employment, leave
event. You must enroll within 60 days of the change event. without pay (including leave under the Family and Medical Leave
Act), or any other reason, and stop contributing to your account,
Once enrolled in the HCSA, you may not change your election your HCSA coverage will be terminated. You will still be able
amount. Your pre-tax deductions will continue throughout the plan to submit claims for expenses that occur on or before your last
year. However, there are certain circumstances where a change in paycheck deduction, but any health care expenses that occur
your annual election may be permitted, as long as the change is after your contributions stop will not be reimbursed.
consistent with the change in your family situation. For example,
if you become married during the plan year, you may increase the However, under certain circumstances you may still continue
amount of your contribution, and if you lose a dependent during the participating in the HCSA after you leave the payroll:
plan year, you may reduce the amount of your contribution. However,
you are not allowed to reduce your election amount to $0 if you have • If you are eligible to elect COBRA coverage, you can make after-
a change in status. Certain events, such as marriage, the birth of a tax payments directly to the FSA administrator, although under
child, or returning to work from an unpaid leave of absence will allow the direct pay option, you won’t save money on your taxes. If
you to enroll during the year. Below is a list of eligible CIS events: you leave the payroll during the plan year (either temporarily
or permanently) and want to continue your coverage, the FSA
administrator will send you a COBRA notice that you must sign
• Change in legal marital status such as marriage, death and return by the specified deadline.
of spouse, divorce, legal separation, or annulment
• Before you retire, terminate employment, or take a planned
• Change in number of eligible dependents due to birth, leave of absence (such as under the Family and Medical
death, adoption, or placement for adoption Leave Act) you can pre-pay your election by increasing the
• The taking of, or return from, an unpaid leave of absence amount of your biweekly deductions to compensate for the
for the employee deductions you expect to miss once you leave the payroll. If
you choose this option, you must contact the plan via email at
• Beginning or end of employment for the employee fsa@goer.ny.gov as soon as possible to arrange for your
• Gain or loss of spouse’s or eligible dependent’s eligibility deductions to be adjusted before you receive your last paycheck.
for health insurance coverage due to a change in • If you return to the payroll during the same plan year, you can re-
employment enroll if you submit a change in status application within 60 days
• Gain or loss of your dependent’s eligibility for health of your return to the payroll. CIS applications will be accepted
insurance by attaining a specified age, due to a change during the plan year until November 1, 2021.
in student or marital status, or because of other allowable • If you leave and then return to the payroll, you may re-enroll, but
circumstances only for the same election amount that you had at the time you
left the payroll. However, you will have two separate periods of
If you have a CIS, call customer service or visit our website at coverage from which expenses can be incurred and reimbursed.
goer.ny.gov/FSA to complete a change in status application. Remember, even if you re-enroll in the HCSA after you return to
Your change in status application must be submitted within the payroll, you will not be reimbursed for health care expenses
60 calendar days of the qualifying event, but as soon as possible to incurred during the time period when you were not contributing
prevent unwanted, non-refundable deductions. You will also need to your account.
to include documentation to support the change request, such
as a copy of a marriage license, divorce decree, birth certificate, What To Do At Tax Time
adoption decree, or death certificate. When you receive your W-2 for the 2021 tax year, the salary
reported in Box 1 will already be reduced to reflect your 2021 plan
The effective date of your new period of coverage and your new year HCSA contributions. You are not required to file any tax forms
election amount will be the date your application is submitted to the to report your HCSA contributions.
FSA administrator or the date of your qualifying event, whichever
is later, unless you are a new employee. If you enroll during the Saving With The HCSA
year as a new employee, your period of coverage will begin on We encourage you to use the online tax calculator to help you
your 61st consecutive calendar day of employment. In addition, estimate the taxes you will save by enrolling in the HCSA. Visit
if you are enrolled in the HCSA when the plan year begins on goer.ny.gov/FSA to use the calculator. You will need your 2019
January 1 and you submit a change in status request during the Federal and State tax returns to calculate your savings, which
plan year, you will have two separate periods of coverage from will depend on a number of factors such as your earned income,
which expenses must be incurred and will be reimbursed. tax filing status, and the amount of your qualifying out-of-pocket
health care expenses.
CIS applications will be accepted during the plan year for events that
occur on or before November 1, 2021. Applications received after
November 1 won’t be accepted because they can’t be processed
in time for the last payroll deduction of the year.
goer.ny.gov/FSA 13HCSA FAQs
Does the HCSA replace my medical plan? No. This program If I have an eligible change in status, can I increase or decrease my
offers you a way to pay for eligible out-of-pocket health care HCSA amount? Yes, however your change must be consistent with
expenses with pre-tax money. You cannot submit expenses the event. The IRS requires that the FSA administrator treat the
for which you have received or will seek reimbursement from periods prior to and subsequent to the change as two separate
your health care plan or other source. You should first submit periods of coverage for reimbursement purposes.
your claims to your health insurance plan. Once you know how
much of your cost is covered, then submit any remaining out- If I was not eligible to enroll in the HCSA during the open enrollment
of-pocket eligible expenses to the HCSA for reimbursement. period, but gain eligibility during the plan year, can I enroll mid-
year? No. A change in eligibility is not a change in status event
Am I required to participate in the New that would allow you to enroll in the HCSA during the plan year.
York State Health Insurance Program What happens if I retire, terminate
(NYSHIP) in order to enroll in the HCSA? employment with the State, or take an
No. If you have coverage elsewhere, you unpaid leave of absence during the year?
may still enroll in the HCSA as long as If you retire, terminate employment, or take
you meet the eligibility criteria. an unpaid leave of absence during the plan
If my spouse or I have health insurance year, your coverage will be terminated once
coverage elsewhere, can I still enroll in you leave the payroll and stop contributing to
or use the HCSA to pay for my family’s your account, unless you plan ahead during
expenses? Yes. You can participate in open enrollment. You can contribute your full
the HCSA even if you are not enrolled annual election before you leave the payroll,
in NYSHIP. which will enable you to use your account for
expenses incurred after you leave.
If my spouse and I are state employees,
can we both enroll in the HCSA? Yes. Any When you apply for enrollment, make sure to
eligible state employee may enroll in the indicate the number of paychecks you expect
HCSA, up to the maximum contribution to receive before you leave the payroll.
per individual for the tax year. However, If you are unable to plan ahead, you may
if both spouses enroll, each health care still continue to participate in the HCSA by
expense can only be reimbursed once. making after-tax COBRA payments directly
to the FSA administrator, or by arranging to
Whose expenses are eligible for reimbursement under the HCSA pre-pay the balance of your annual election before you leave the
program? The HCSA may be used to reimburse health care payroll. Email the plan at fsa@goer.ny.gov if you wish to arrange
expenses for you, your spouse, and anyone who is defined as a pre-payments.
qualifying child or qualifying relative by the Internal Revenue Code.
I am an adjunct professor at a state university, and don’t expect to
Are my domestic partner’s health care expenses eligible for receive paychecks during the summer months. Will that affect my
reimbursement from my HCSA? According to the IRS, health care participation in the HCSA? Yes. If you are an adjunct employee and
expenses for a domestic partner cannot be reimbursed through leave the payroll at the end of the spring semester, your coverage
the HCSA unless the domestic partner qualifies as a dependent will be terminated once you stop contributing to your account.
under the Internal Revenue Code. However, if you plan ahead during the open enrollment period
and select the option of contributing your full annual election by
Are expenses that are reimbursed by the HCSA eligible to be the end of the spring semester, your participation will continue
deducted on my tax return as a medical expense? No, because uninterrupted after you leave the payroll.
you have already received reimbursement with tax-free dollars.
Only expenses that are not reimbursed through an insurance What happens to the money in my account if I separate from state
plan, some other source, or the HCSA may be deducted on your service during the plan year? Can I use it after I leave? If you retire,
income tax return. leave state employment, go on leave without pay, or otherwise
stop contributing to your account, the money in your account can
What happens if my medical expenses change during the plan year? only be used for services that occurred before you left the payroll.
Can I increase or decrease my HCSA contributions? No. According However, if you continue to contribute to the HCSA after you
to IRS rules, a change in medical expenses is not a qualifying event leave the payroll by making after-tax payments directly to the FSA
that would allow you to change the amount of your HCSA annual administrator, or if you pre-pay the balance of your annual election
election. So, if you incur more medical expenses during the plan before leaving the payroll, you will be able to submit claims for
year you cannot increase your HCSA contributions. If your medical services that occur after you leave your state job.
expenses are less than you had planned, you cannot reduce your
HCSA contributions.
14 800-358-7202HCSA FAQs Can I request reimbursement from the HCSA for services I receive Will the plan pay for upgrades to my prescription glasses? Yes. You before the plan year begins if I am not billed until after the plan can be reimbursed for the cost of upgrades or add-ons (such as year starts? No. According to IRS guidelines, a qualified expense scratch-resistant coating) to your prescription lenses and frames. is “incurred” at the time the service is provided, not when you There is no limit on dollar amounts of the upgrades or add-ons. are billed (or charged) or actually pay for the service. Therefore, Non-prescription glasses, warranties, and sunglasses are not reimbursements made during a plan year are only for eligible reimbursable. medical services received during that same plan year. Can health care services that require upfront payment to the provider be reimbursed from the HCSA in a single plan year, even if the health care is delivered over several plan years? No. IRS regulations do not allow medical expenses to be reimbursed through the HCSA until they have been incurred. Expenses are not incurred until treatment is provided to the participant, regardless of when the participant pays the provider. How do I know if my child’s orthodontia will be reimbursed? How are orthodontic expenses reimbursed if I pay my provider on a monthly payment plan? Orthodontic expenses are a reimbursable expense through the HCSA. At the beginning of the plan year in which you first request reimbursement for these expenses, you must submit a copy of the service contract between you and the orthodontist describing the payment arrangement/schedule. Orthodontia costs that are paid on a monthly payment plan will be reimbursed after each monthly payment is due. However, if you pre-pay the entire cost of orthodontia treatment up front, you will only be reimbursed in a particular plan year for the value of the services that will be provided during that plan year. You must submit a claim for the pro-rated monthly amount on or after the beginning of each month of service, since you will not be reimbursed automatically. See page 5 for more information. Are dental implants reimbursable? Yes. Dental implants are reimbursable as long as they are not a cosmetic treatment. Will the HCSA reimburse the cost of my prescription drug, even if my insurance plan won’t pay for part of it? Any prescription drug can be reimbursed as long as it is used to treat a medical condition. Prescription drugs that are primarily used for cosmetic purposes can’t be reimbursed. Can over-the-counter drugs, herbal medicines, and homeopathic remedies be reimbursed if my doctor or medical provider prescribes them to treat my medical condition? OTC drugs, medicines, and biologicals are eligible for reimbursement under the HCSA. Dietary supplements and vitamins are reimbursable if recommended by a doctor to treat a medical condition, and if your claim for the expense is submitted with a letter of medical need written by your doctor. However, herbal medicines and homeopathic remedies are not reimbursable under the HCSA. Can travel expenses related to my medical care be reimbursed through my HCSA? Yes. The IRS permits you to be reimbursed for amounts paid for transportation primarily for, and essential to, medical care. You can receive reimbursement for car mileage (17 cents per mile in 2020), parking fees, tolls, subways, buses, trains, air travel, and lodging if the costs are incurred primarily to receive medical care. goer.ny.gov/FSA 15
Dependent Care Advantage Account
The IRS requires you to provide the name, address, and taxpayer
What Is The Dependent Care Advantage identification number (or social security number) of the person
Account? providing the care. You must provide this information when you
The Dependent Care Advantage Account (DCAA) is a negotiated submit a claim and when you file IRS Form 2441 with your income
employee benefit that helps state employee families pay for tax return.
custodial child care, elder care, or disabled dependent care while
they are at work. Employer Contribution
The employer contribution is an amount of money that NYS will
Who Is Eligible To Enroll? deposit into employees’ DCAA when they enroll. The employer
contribution was negotiated during collective bargaining to help
Employees who work for Executive Branch state agencies, the
employees with the high cost of dependent care expenses.
State University of New York, the Legislature, and the Unified Employees only need to enroll in the DCAA and their employer
Court System are eligible to participate in the DCAA. Part-time and contribution will be contributed to their accounts, if they are eligible.
hourly employees are eligible as long as their biweekly paychecks The employer contribution is included in the employee’s annual
can support their DCAA deductions. Employees of NYS Energy election amount. The DCAA employer contribution will be available
Research and Development Authority (NYSERDA), Environmental in 2021 for unions that have agreements to participate in the
Facilities Corporation (EFC), New York Liquidation Bureau, and employer contribution program. The following employees are
Roswell Park Cancer Institute are also eligible to participate. currently eligible for the employer contribution:
New employees are immediately eligible for this benefit, but must • Employees of Executive Branch state agencies, Roswell Park
enroll within 60 days, inclusive, of their hiring date. The plan year Cancer Institute, or State University of New York who are
contribution amount will then be pro-rated over the remaining pay designated M/C or represented by CSEA, UUP, NYSCOPBA,
periods in the calendar year. GSEU, or DC-37.
• Employees of the Unified Court System, except those designated
Who Is Not Eligible To Enroll? unrepresented (Negotiating Unit #88).
Employees paid on a fee basis are not eligible to participate in • Employees of the Legislature, NYSERDA, or EFC.
the DCAA.
If Your Salary Is... The Employer Contribution Is...
What You Need To Know Before Enrolling Under $30,000 $800
The maximum you may put into the account is $5,000 or $2,500
based on your tax filing status. $30,001 - $40,000 $700
• If you or your spouse earn less than $5,000 annually, you $40,001 - $50,000 $600
cannot put more money into the account than your income or $50,001 - $60,000 $500
your spouse’s income — whichever is less. $60,001 - $70,000 $400
• If you use the “Married Filing Jointly” tax filing status the IRS Over $70,000 $300
$5,000 maximum contribution rule is applied to households.
GSEU Employees only $600
• If both you and your spouse participate in a dependent care (regardless of salary)
FSA the total household contribution is limited to $5,000.
The employer contribution may be available to state employees in
• If you file as “Head of Household”, the IRS maximum contribution
other bargaining units for the 2021 plan year pending conclusion of
is $5,000.
negotiations and ratified contracts. Based on salary, the employer
• If you use the “Married Filing Separately” tax filing status, the contribution may provide up to $800 for eligible employees who
IRS limits contributions to $2,500. enroll in the DCAA. For employer contribution updates please
• If you use the “Single” tax filing status, the IRS limit is $2,500. visit the FSA website at goer.ny.gov/FSA or call 1-800-358-7202.
Expenses must be for service provided from January 1 through
December 31 of the plan year.
If the services are for child care, your child must be under age
13 and must be your dependent as defined by federal tax rules.
Services for a child or adult of any age are eligible if they are
disabled and unable to care for themselves and spend at least
eight hours of the day in your home.
The services may be provided either in your home or elsewhere,
but not by someone whom you also claim as your dependent for
income tax purposes. You may not pay your older child to care
for your younger child or elderly parent.
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